Cigna Vedolizumab (Entyvio) prior authorization requirements (2026)
What Cigna generally requires to approve Vedolizumab (Entyvio) (CPT J3380), for Commercial plans. Yes. Cigna generally requires prior authorization for Vedolizumab (Entyvio) (CPT J3380).
Medical-necessity criteria Cigna generally applies
Prior authorization required (prescribed by/with a gastroenterologist; age 18 or older). Moderately-to-severely active Crohn's disease or ulcerative colitis. Dosing 300 mg IV at weeks 0, 2, and 6, then no more frequently than every 8 weeks. Initial approval 6 months; continuation 1 year if established at least 6 months with a beneficial clinical response (improvement in at least one symptom).
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Vedolizumab (Entyvio). Confirm the covered diagnosis list against the current Cigna policy.
Commonly required documentation
- Diagnosis (moderate-to-severe CD or UC)
- specialist prescriber
- response measure for continuation.
Situations to verify before submitting
Cigna may not cover Vedolizumab (Entyvio) in these situations. Verify against the current policy rather than assuming a denial:
- Should not be administered in combination with another biologic used for inflammatory conditions
How to submit
- Method: Cigna / Express Scripts prior authorization
- Portal: Cigna Provider (CHCP)
Source
Source: Cigna Coverage Policy IP0674 Entyvio Intravenous (eff 2026-05-15). Code J3380. No preferred-product/step requirement (upfront Entyvio permitted). Last verified 2026-06-17.
Frequently asked questions
Does Cigna require prior authorization for Vedolizumab (Entyvio)?
Yes. Cigna generally requires prior authorization for Vedolizumab (Entyvio) (CPT J3380).
What does Cigna require to approve Vedolizumab (Entyvio)?
Prior authorization required (prescribed by/with a gastroenterologist; age 18 or older). Moderately-to-severely active Crohn's disease or ulcerative colitis. Dosing 300 mg IV at weeks 0, 2, and 6, then no more frequently than every 8 weeks. Initial approval 6 months; continuation 1 year if established at least 6 months with a beneficial clinical response (improvement in at least one symptom). Always confirm against the current Cigna policy.
How long does a Cigna prior authorization take?
Turnaround varies by plan and submission method. Check the Cigna portal for current timeframes.
Submitting Vedolizumab (Entyvio) to Cigna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.